Limb salvage surgery with vascular reconstruction

Vascular reconstruction and limb salvage surgery has been the authors' preferred approach when malignancy involves major vessels of the extremities. Treatment of 16 patients involved resection, with vascular grafting in 14 patients and rotationplasty in two patients. The major vessels were surrounded by tumor in six patients, nearly encased in three patients, invaded by tumor in four patients, and widely contaminated by intralesional surgery in three patients. The tumor stage included one Stage IB, 12 Stage IIB, two Stage IIIB sarcomas, and one multiply recurrent carcinoma. The largest average tumor dimension was 9.5 cm, and the length of grafting was 14 cm. Major nerves were sacrificed in eight (50%) patients, flaps or muscle transfers were done in seven (44%), chemotherapy was administered in nine (56%), radiation therapy was used in four (25%), and pulmonary metastasectomy was done in two (12%). At a mean followup of 56 months, 50% (eight of 16) of patients were alive without disease. Local recurrence was 12% (two of 16 patients), and infection was 12% (two of 16 patients). Limb salvage was achieved in 88% (14 of 16 patients), and functional status was judged good or excellent in 81% (13 of 16 patients). The complication rate observed in this subset of patients is significant, yet local control and the incidence of major complications was acceptable. Results observed from this series and data gathered from the literature clearly indicate that patients can avoid amputation, despite malignant involvement of major vessels to their extremities.